Proposal Title: Organizational Factors Related to Hospital Readmissions PI: Chuan-Fen Liu, PhD Objectives: Hospital readmissions are frequent and costly, and reflect poor quality of care. VA hospital readmissions represent a largely unrecognized and unmeasured burden on veteran patients and their health care providers. Over the past decade, VA has implemented significant organizational changes to improve quality of care. However, we have no systematic data on variation in readmission rates across the VA health care system or on the facility-level factors that may affect readmission rates. Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are the top two medical discharge diagnoses for both VA and Medicare. This study has two specific aims: 1) to assess hospital readmission rates and costs of readmissions among VA inpatients with HF and COPD, and hospital-level variation in readmission rates and costs for these patients; and 2) to identify hospital-level organizational factors associated with variation in readmission rates. Research plan: This study uses a retrospective cohort study design. Data sources will include VA national administrative datasets, Medicare and Medicaid claims, Chief of Staff organizational surveys administered by the VA Office of Quality and Performance, organizational data collected by other QI and research studies, and a new written survey of VA Chiefs of Medicine or Pulmonology. Methodology: Aim 1 will use retrospective VA administrative data and Medicare claims data to describe variation in readmission rates and costs of readmission, and to identify high- and low-performing VA facilities using these metrics. The descriptive assessment proposed in Aim 1 will incorporate non-VA data and appropriate risk adjustment methods in a logistic regression model to develop accurate assessments of readmission rates and costs. For Aim 2, we will adapt an existing survey on resources available for managing heart failure patients and discharge policies for heart failure admissions to collect similar data on COPD management, to supplement existing facility-level organizational data. We will target Chiefs of Medicine or Pulmonology at all VAMCs with acute inpatient care. We will use new survey data and existing organizational survey data to identify hospital factors associated with variation in hospital readmissions and total costs of readmissions.